Kaleidoscope of the Heart: From what age can we make our own decisions?

Often I debate with my students in my university classes, "From what age do you think children can make their own decisions about themselves?" Recently in the area of medical treatment, there are many places that are prioritizing the personal decision of the patient above all else. For example, even if someone has a serious illness, their condition is clearly explained to them by their doctor, and they make their own decisions about how to proceed with treatment.

Even in the psychiatric field in which I work, we ask, "Will you take medication?" and explain the merits and demerits of the medicine, ultimately working to respect the patient's wishes. Of course, in cases where it is obvious that medication is essential, even if the patient says that they don't need it, we make it very clear that we think they should take it.

Amid the trend of allowing patients to make their own decisions, we come to the question of just when children can make those kinds of decisions. Until now in Japan, the norm has been, "If the individual is a minor, the doctor speaks to the parents about treatment and consults with them about their opinions." But lately, there are more doctors that believe, "If a patient is perhaps a junior high or high school student, their condition should be clearly explained to them and their feelings should be heard."

When I ask my university students about this, the trend that I find is that the lower the age of the student being asked, the lower the age of decision-making they give. If I ask a first-year university student, the majority of whom are still 18 years old, they still vividly remember their own childhoods and appear to be confident that "I definitely considered a lot of different things when I was in elementary school." Among them are some who bring up particular experiences, saying, "When I was in kindergarten, my parents decided to move without saying anything to me. I was very upset. I wish they would have asked me what I wanted to do."

When I hear stories like that from young university students, I can't help but notice, "Huh. Even children who we think are still much too young to decide things on their own are thinking about things earnestly and forming their own opinions." Children certainly feel that the more serious something is, the more they don't want to be "treated like children."

The same can probably be said for the elderly. While we may consider it kind to save them from a difficult decision by deciding for them, consulting with the person directly involved should be basic common sense. Whenever I have an elderly or child patient, I already think I may find myself turning to their attending family members to talk about issues like treatment, but I will do my best to remind myself to talk to the patient first. (By Rika Kayama, psychiatrist)